Familial adenomatous polyposis - Efficacy of endoscopic and surgical treatment for advanced duodenal adenomas

INTRODUCTION: Duodenal and periampullary cancer is the most common cause of cancer death in patients with familial adenomatous polyposis who have unde rgone colectomy. Endoscopic surveillance of upper gastrointestinal adenomas is recommended for patients with familial adenomatous polyposis but the ti ming and appropriate treatment of neoplasms is unknown. The purpose of this experiment was to report our experience with endoscopic and surgical treat ment of advanced duodenal adenomas in patients with familial adenomatous po lyposis. METHODS: The records of all patients with familial adenomatous pol yposis who had undergone surgical or endoscopic treatment for duodenal aden omas were identified. Data including endoscopic surveillance findings, type of intervention, pathology, and followup of the lesions were reviewed. RES ULTS: Ten neoplasms >1 cm were treated in eight patients (mean age at the t ime of diagnosis was 49 years). Nine lesions were histologically advanced. Five lesions involved the papilla. Endoscopic treatment was performed for s ix lesions. Four lesions recurred, and three were then treated surgically. Local resection was performed for five lesions. Four lesions recurred and t wo had further operative intervention. Pancreas-sparing duodenectomy was pe rformed in three patients. At a mean follow-up period of 45.7 months, there has been no recurrence. CONCLUSIONS: Endoscopic eradication is an appropri ate initial treatment for histologically advanced, noncancerous neoplasms o r for patients who are not surgical candidates. Pancreas-sparing duodenecto my may be the treatment of choice for patients with carcinoma and those who have failed endoscopic therapy.